I had a migraine a few weeks ago. As migraines go it was a breeze, really. There was no piercing headache, just a vice-like tension that I would normally associate with the before- and, to some extent, the after-effects. It was not a muscular tension-headache nor alcohol-related.
I didn’t experience the normal visual aura, but I’m sure it was a migraine because it was preceded by a strange faintness accompanied by shifting vision. I felt funny for most of the following week, then had a severe headache last Friday. The previous day I’d worked out hard in the gym. So I took medical advice. They said it was probably a virus that had triggered the original migraine; it was not surprising for the symptoms to be there a week later. Take paracetamol, they said. You’ll be fine. And so it turned out.
I’ve had one or two really severe migraines, but I’ve been very lucky. Apart from the couple in my teenage years that would conform to the agonising archetype blighting many people’s lives, I’ve been a light sufferer, by any measure. For 10 years of adulthood I had none. Then just a handful with no pattern or recognizable trigger. And some of those were easily knocked on the head by the early ingestion of paracetamol.
Most recently, my first half-marathon triggered one. And after the London marathon in 2005, I succumbed. In both cases my training had been incomplete: I’d overstretched myself. That would constitute a huge stress: an obvious trigger. I’ve wondered too if the demand for calcium/magnesium following that excessive hammering on bones and joints might not have helped. Too much to know.
Because I’ve escaped lightly, my knowledge of the significant progress of migraine science has been almost (but not entirely) non-existent. I noticed only yesterday, for instance, that Oliver Sacks wrote a book called Migraine in 1970 (with a revised edition published in 1992).
But the subject hove back into my view for a couple of reasons recently. I learned, for instance, that migraine as a neurological condition has a close genetic alignment with epilepsy, and that migraine sufferers are more susceptible to background noise; there is a similar phenomenon (which I don’t fully understand) in relation to eyesight.
My late brother suffered from epilepsy. But, because his epilepsy was apparently brought under control by a similar progress of pharmaceutical research, the family had been largely able to forget the underlying seriousness of a condition which reportedly affects 60 million people worldwide; migraine, by contrast, may affect as many as 300 million. The general impression — certainly one that my brother held — was that the major risk to his health came from the long-term effect of such chronic drug dependency on his vital organs. But it seemed that we could feel blessed that it wasn’t a whole lot worse; going back a generation or two, some family members’ lives had been completely wrecked, and this had chronic knock-on consequences for their carers. These days there are still those whose condition does not respond to treatment.
So, when I was researching my earlier post on Didier Sornette and the housing market, I came across a presentation he delivered in Oxford in January. It revealed some of the wider applications of complexity theory beyond the geophysics where Sornette started. In collaboration with several others, Sornette has published a paper or two explaining how the study of data sets of the brain activity of epileptics (specifically those whose condition does not respond to drugs) showed patterns akin to seismic data of earthquake incidence. The hope is that this might lead to some better method of prediction for sufferers.
The maths is rather intimidating and I’ll try to paraphrase the following as I go along, and link to definitions. Fingers crossed:-
That the pdf [probability density function] of SZ [seizure] energies E follows a power law, and more importantly that its exponent is beta almost equal to 2/3 (as for EQ [earthquake]), has far-reaching, statistical-clinical implications: the mean and variance of E are mathematically infinite, which means in practice that the largest SZ in a given time series controls their values (3). As a consequence, variability is dominant and “typical” has no meaning. The energy pdf, and specifically its heavy tail, also suggests an explanation, at a mathematical-conceptual level, for the proclivity and capacity of the human brain to support status epilepticus, a potentially fatal condition characterized by prolonged/frequent SZ during which the brain does not return to its “normal” state, even when SZ activity abates.
Well, I think the key point is ‘variability is dominant and “typical” has no meaning’, which we liberal artists would tend to capture with the expression ‘to be in a constant state of flux’ although that does not quite cover the sense of unbounded potential for an extreme spike. The problem is that we like to convince ourselves that there is some “normal”, some stability. And, on the surface, so it may appear.
And then Sornette explains:-
In seismology, it has been recognized that the many small, undetected EQ provide a major if not dominant contribution to the triggering future of EQ of any size (7). Prolonged recordings of brain cortical electrical activity (ECoG), the equivalent of seismographs, from epileptic humans and animals contain frequent, low intensity, short bursts of abnormal activity unperceived by the patient and observers and interspersed with infrequent, but longer, more widespread, and more intense bursts (convulsions) (4). The SZ-EQ analogy, including the evidence presented here for an inherent capacity of SZ to trigger future SZ, suggest that a workable prediction scheme should use the triggering by, not only past perceived (clinical) SZ, but also the myriad of unperceived (subclinical) abnormal neuronal bursts.
Sornette’s applied work highlights the cross-disciplinary relationship of the science of complexity and reminds us too that some part of our population suffers from extreme non-linearities in their day-to-day lives. And how more vivid can it be, as the picture above shows, than the fractal manifestation that is the migraine aura; when I first used to experience it, it would mark the beginning of hours of debilitation.
Meanwhile, news was reported a few weeks ago that untreatable epilepsy in children responded to a high-fat/low-carbohydrate diet. This is not particularly new. I notice now that Mark’s Daily Apple picked up a Science Daily report back in January to similar effect. Mark was also the original pointer to the picture above (thanks again Mark). So-called ketogenic diets have been known to be effective in treating even the worst sufferers from epilepsy as far back as the 1920s. And I even found a 1910 medical report quoted on a low-carb forum where a doctor had noted high levels of candy consumption among two chronic epileptic sufferers, one adult, one child, he’d been asked to treat. Drug therapies became preferred later because the higher-fat diets were found to be more difficult to follow, ostensibly for cultural reasons. Today there is a shortage of dieticians to help apply what you might call a clinical diet, where each gram of carbohydrate is very closely measured.
Well, it makes more and more sense to me that diet — and our modern carb-laden diet — has much more to answer for than we allow when we think that we are eating a “healthy mixed diet”. But it’s a struggle to remove easy grain-based carbs, and one has to wonder whether it is a sustainable option for the planet as a whole. Since I can afford it, I’m making the switch, but mainly because of the evidence that grains may play a role in activating cancer genes. I can’t ignore those pointers; I’m 43 and since January the oldest surviving member of my immediate family. Both my parents lived ostensibly healthy lives. That alone should predict that at least one would still be with us since my grandmother was alive just 7 years ago at 91.
Because of the complex, fast-moving chain of events that led to my brother’s death in January, it was hard for the surgeons to provide the family with a satisfactory narrative. I missed the chance to speak in person with the clinician; I was racing down the interstate in (melo)dramatic fashion in order to arrive before what turned out to be a technical pronouncement of death. My brother’s state on arrival in hospital the previous day was not materially different from when I arrived 10 minutes after the certification; he was on life-support simply for the purposes of organ-donation.
But that does not matter. What was described was a total neurological event — a seizure that affected all his vital functions. SUDEP — or sudden unexplained death in epilepsy — is what I understand it to have been, although that was not the word the doctor used. Or perhaps it was status epilepticus.
It’s ironic that neither SUDEP nor status epilepticus was something we knew about beforehand, or ever discussed as a possibility within our family. As I said, my brother’s principle pre-occupation in terms of epilepsy-related health (based on counselling I assume he received quite early on in his life) was that his long-term health would be compromised by the medicine he took rather than the diet he was exposed to. I think it made him fatalistic. I have no recollection that a low-carbohydrate diet would have improved his teenage outcomes, and it was something my mother would surely have responded to, had she known.
Later in life, my brother ate a standard North American diet, and there is no suggestion that this was a contributory factor to his SUDEP, but I have to wonder. Not least because the science of low-carb and the science of earthquakes both point to epilepsy from different perspectives. And scientists like Sornette and De Vany are using the same maths across these various domains.
Changing diet may not be a panacea, and I may already have sown the seeds of my own demise, but you don’t not pay into a pension scheme because you didn’t pay in before. That sort of fatalism does lead to literal and metaphorical penury. But above all else, these findings all suggest that a lot more critical reporting should be applied to questions of public health, preventative medicine, exercise, diet fads and even agricultural subsidy. That obviously ain’t happening at the moment. Indeed, the recent coverage of the ketogenic diet in the BBC/Lancet does not consider whether a lower carb diet contributes to a reduced risk of seizure more generally, and therefore might act to forestall a sufferer reaching the kind of tipping point that Sornette’s science is point toward. It is dealt with in the specific of untreatable epilepsy with no extrapolation that more general metabolic risk factors need to be considered or highlighted for all sufferers.
Well, when I asked in one of the leading cookery shops with a vast, if not complete, array of cookery titles if they had anything on the paleo diet, they had no clue what I was talking about, unsurprisingly. So there is much work to be done. That said, Nassim Taleb‘s advocacy in The Sunday Times the other day certainly has led to more Googling of “paleo diet” and other associated terms, from what I can see here, including searches for Prof De Vany.
Photo credit Auntie P @ Flickr (CC)Donate and help me buy back my Fender ('About' tells you why) Tags: art-de-vany, complexity, didier_sornette, earthquakes, epilepsy, low-carb, migraine, Nassim-Taleb, Oliver Sacks, paleo-diet, SUDEP